Comparative evaluation of i-gel(®) insertion conditions using dexmedetomidine-propofol versus fentanyl-propofol - A randomised double-blind study

BACKGROUND AND AIMS: i-gel(®) insertion necessitates adequate depth of anaesthesia to prevent laryngospasm, gagging or limb movements. We aimed to compare i-gel(®) insertion conditions with propofol induction after pre-treatment with dexmedetomidine or fentanyl. METHODS: Eighty ASAI/II patients undergoing general anaesthesia were randomised into Groups D (n = 40) and F (n = 40). Group D received 1 μg/kg dexmedetomidine over 10 minutes followed by 5ml of 0.9%normal saline (NS) over 2 minutes. Group F received 10 ml of 0.9%NS over 10 minutes followed by fentanyl 1 μg/kg over 2 minutes. Thirty seconds after study drugs, propofol 2 mg/kg was given. Ninety seconds after propofol, i-gel(®) was inserted. Overall insertion conditions were assessed by Modified Scheme of Lund and Stovener. Heart-rate (HR) and mean arterial pressure (MAP) were noted at baseline, after study drug, propofol induction and 1,3,5,10 minutes after i-gel(®) insertion. Respiratory rate and apnoea times were recorded. RESULTS: Insertion conditions were comparable between both groups. Moderately relaxed jaw, coughing and movement was observed in more patients of Group F. Incidence of apnoea was significantly higher (P < 0.0001) in group F (18/40) than group D (3/40).Mean duration of apnoea in group F (284.5 ± 11.19 sec) was significantly higher than group D (217.17 ± 16.48 sec). Percentage drop in MAP from baseline after propofol was more in group F (10.3%) than group D (5.6%). MAP after induction was significantly lower in group F compared to group D (P = 0.002), but similar after i-gel(®) insertion, 1,3,5 and 10 minutes after insertion. After propofol (P = 0.003) and i-gel(®) insertion (P < 0.001), HR was significantly lower with dexmedetomidine. CONCLUSION: Dexmedetomidine and fentanyl provide comparable conditions for i-gel(®) insertion with propofol.